Department of Surgery, Matsuyama Red Cross Hospital, 1, Bunkyomachi, Matsuyama City, Ehime, 790-8524, Japan.
BMC Gastroenterol. 2022 Aug 26;22(1):398. doi: 10.1186/s12876-022-02478-5.
This study aimed to determine which running pattern of the left gastric vein (LGV) is most frequently ligated in subtotal stomach-preserving pancreatoduodenectomy (SSPPD) and how LGV ligation affects delayed gastric emptying (DGE) after SSPPD.
We retrospectively analysed 105 patients who underwent SSPPD between January 2016 and September 2021. We classified the running pattern of LGV as follows: type 1 runs dorsal to the common hepatic artery (CHA) or splenic artery (SpA) to join the portal vein (PV), type 2 runs dorsal to the CHA or SpA and joins the splenic vein, type 3 runs ventral to the CHA or SpA and joins the PV, and type 4 runs ventral to the CHA or SpA and joins the SpV. Univariate and multivariate analyses were used to identify differences between patients with and without DGE after SSPPD.
Type 1 LGV running pattern was observed in 47 cases (44.8%), type 2 in 23 (21.9%), type 3 in 12 (11.4%), and type 4 in 23 (21.9%). The ligation rate was significantly higher in type 3 (75.0%) LGVs (p < 0.0001). Preoperative obstructive jaundice (p = 0.0306), LGV ligation (p < 0.0001), grade B or C pancreatic fistula (p = 0.0116), and sepsis (p = 0.0123) were risk factors for DGE in the univariate analysis. Multivariate analysis showed that LGV ligation was an independent risk factor for DGE (odds ratio: 13.60, 95% confidence interval: 3.80-48.68, p < 0.0001).
Type 3 LGVs are often ligated because they impede lymph node dissection; however, LGV preservation may reduce the occurrence of DGE after SSPPD.
本研究旨在确定在保留部分胃的胰十二指肠切除术（SSPPD）中最常结扎的胃左静脉（LGV）的走行模式，以及 LGV 结扎如何影响 SSPPD 后的胃排空延迟（DGE）。
我们回顾性分析了 2016 年 1 月至 2021 年 9 月期间接受 SSPPD 的 105 例患者。我们将 LGV 的走行模式分为以下 4 种类型：1 型走行于肝总动脉（CHA）或脾动脉（SpA）背侧与门静脉（PV）汇合，2 型走行于 CHA 或 SpA 背侧与脾静脉汇合，3 型走行于 CHA 或 SpA 腹侧与 PV 汇合，4 型走行于 CHA 或 SpA 腹侧与脾静脉汇合。使用单因素和多因素分析来识别 SSPPD 后有和无 DGE 的患者之间的差异。
47 例（44.8%）患者存在 1 型 LGV 走行模式，23 例（21.9%）患者存在 2 型，12 例（11.4%）患者存在 3 型，23 例（21.9%）患者存在 4 型。3 型 LGV 的结扎率显著较高（75.0%）（p<0.0001）。单因素分析显示，术前阻塞性黄疸（p=0.0306）、LGV 结扎（p<0.0001）、B 或 C 级胰瘘（p=0.0116）和脓毒症（p=0.0123）是 DGE 的危险因素。多因素分析显示，LGV 结扎是 DGE 的独立危险因素（优势比：13.60，95%置信区间：3.80-48.68，p<0.0001）。
3 型 LGV 常被结扎，因为它们妨碍淋巴结清扫；然而，保留 LGV 可能会降低 SSPPD 后 DGE 的发生。
